Emergency Room Manager

Veroniche

Western Region, US

Female, 54

I’ve been an ER nurse manager since 2009. Previously, I spent 24 yrs as an ER nurse. My hospital, a Level III trauma center, sees 70,000+ ER patients/yr. My responsibilities include billing, federal/state regulation oversight, metrics reporting, software education of e-records, and hiring/termination/disciplinary actions. The ER is one of the key impacted areas of healthcare reform. It’s a scary and exciting time for us, not just in the care of patients, but what the future holds for healthcare.

Ask me anything!

What do YOU do?

If someone lands in the ER after overdosing on illegal drugs, are you required to alert the authorities?

Asked by Rx over 6 years ago

No. The nurses and doctors are not the police, and that is not a part of our job. The medical treatment any patient receives is protected health information and we cannot release that info to anyone unless the patient oks it, or it is subpeonaed in an investigation. Even though some drug use is illegal, substance abuse is considered a medical problem. However, if, in the course of treating a patient, we find that there might be child neglect or domestic abuse or that a crime against another person has happened, we are obligated to report that. Each state has mandatory reporting laws around abuse. But we are reporting the suspected abuse of another person, not the drug use of the patient. If we find illegal drugs or pipes, etc. on a patient, we do call the police and they come and get the stuff, but in our ER I have not seen the police arrest anyone for that after we have called them. They may check for any outstanding warrants, and who knows what that may lead to. We have great relationships with our local law enforcement, but we don't do their job and they don't do ours.

What's the most bizarre thing you have seen? Or perhaps the craziest thing you have seen someone put in a bodily orifice?

Asked by tjspot over 6 years ago

The creepiest thing I have seen, I wouldn't call it bizarre, but I will never forget it--a patient came in with his arm amputated just above the wrist in a farming accident. When there is a chance to put the part back on, there is always a staff member whose responsibility is to take care of the amputated part. In this case, it was me. I opened the cooler (the patient had been flown in from a rural area), and the arm was just lying there in a plastic bag in a container on ice. It reminded me of "Thing" from the Addams Family. I almost expected the hand to climb out of the cooler by itself. By the way, the surgeons were able to reattach the hand and with a lot of physical therapy, it ended up being a pretty functional hand.
Anything you can imagine has been put in a bodily orifice. From the common Lego up the nose, bean in the ear, lost tampon (how do you forget about a tampon?), and you can let your imagination run wild, it has probably happened. There are stories all over ERs about this, but this one was one of my patients--a young man inserted a thin glass chemistry tube about the size of your pinky into his urethra. He had to go to the OR to get that removed.
This was not in an orifice, but here is the scenario--I was there. A gentleman had placed a common hex bolt around a certain body part and low and behold it became stuck. It became a medical emergency because the blood flow to the body part was being stopped and it was becoming blue, no blood flow. We had to get a pair of bolt cutters from the hospital engineers, and the physician who happened to be 9 months pregnant, was leaning over the gurney trying to get enough strength to cut that 3/4 inch bolt off before he lost his member. She's nearly in labor, he is screaming and thankfully it worked. After about an hour, he regained blood flow and his pain went away. He said "thanks" and walked out the door. Whatever....
I'm sure there are better stories out there, but I only want to refer to what I've seen or done myself.

Do ER employees eventually get desensitized to morbidity?

Asked by TrimTebow over 6 years ago

You compartmentalize your life, you have to or you couldn't function day to day. There is a lot of sick humor among staff in the break room. I think that if you don't deal with it as it happens and talk about it honestly with a friend or co-worker, you will eventually burn out or develop self-destructive behaviors. ER nurses are a lot like police officers or firefighters/first responders. There is a lot of substance abuse and depression among us. ER nurses do not come to work impaired (generally), but there is a lot of alcohol use outside of work to deal with what we see on a daily basis.

Heh, you guessed exactly what happened > viral tonsillitis that they were concerned would obstruct my airway, and yes: morphine is awesome (i was uninsured and "negotiated" bill down to $3,000). One more Q: is there a bright-line rule as to what constitutes an "emergency" that qualifies for the "cannot-refuse-treatment-even-if-uninsured" mandate? If a patient comes in after discovering a lump in her breast, do you have an obligation to treat her? It may not be an urgent-care scenario but hard to say that it's not "life-or-death" in a broader sense.

Asked by tonsils over 6 years ago

The question of “what constitutes an emergency” has resulted in reams and reams of interpretations by government and private sector lawyers. Remember Bill Clinton and his statement “it depends on what the definition of ‘is’ is”….
Generally speaking emergency refers to immediate life threatening injury or illness. What does “immediate” mean? Yikes, I’m drowning in paperwork!!!
We actually have patients who come into the ER because they have found a lump in their breast. We examine them, they might have a life threatening breast abscess, who knows until you look at it. For someone who has a lump like you may be referring to is sent to their primary care physician for follow-up. There is not an emergency mammogram. If a patient does not have a doctor, we give out referrals to clinics in the area. We also have a full time ER case manager/social worker that can help the person navigate the system. When a person doesn’t have insurance or any money, then we refer to one of the many clinics that have a sliding scale fee schedule—one of our hospital clinics has that. Sometimes it is not easy to get an appointment, and we try to help set that up sooner rather than later.
Speaking of cancer, you would not believe the number of patients that come to the ER and we find a first diagnosis of cancer. The ER is not where you first want to hear that you have cancer.

Why aren't there more (and better) food & drink vending services in ER waiting rooms? Folks are waiting for hours, often bored and hungry -- seems like a wasted revenue opportunity when I only see one vending machine filled with snacks from 1974.

Asked by Trooper1 over 6 years ago

We have one food vending and one drink vending machine in the ER and all of the revenue goes to the vending companies. The can of Coke is $1.50!! If someone needs something more, we direct them to our 24 cafeteria or the cafe in the hospital lobby. A while back, the ER provided free coffee and juice in the waiting room, but it cost about $8000. With budgets being trimmed, that was one of the first things to go.
One of the things that frustrate ER staff is a patient who comes in with belly pain and says that they have been vomiting all night and they walk in with a bag of Cheetos or a bunch of food from Taco Bell. That doesn't help your credibility that you have an emergency.
Our ER length of stay (how long you are in the ER, including time in the waiting room) averages about 3 hours. Hopefully a person can be without their Coke or Snickers that long.

Does it frustrate you and your staff when people use the ER for non-emergencies?

Asked by funnygirl over 6 years ago

Yes, sometimes it can be annoying, especially when you see the same patients over and over, and you have given them referrals for clinics and primary care doctors for their follow-up. In the past 6 months, our ER has seen an increasing number of "clinic" type visits vs. true medical emergencies. Most of these patients are un-insured or under-insured. Also, many patients are using Emergency Departments to get controlled substance prescriptions such as oxycodone or hydrocodone who either do not have a primary care physician or are using the ED for their addiction/dependence. We could have a big discussion just about that and how it is affecting the ER.
That being said, we may give referrals to patients until the cows come home, but if the primary care doctors are not taking new patients, or not taking Medicaid/Medicare patients, or not seeing uninsured patients, there is not much the ER can do. The ER is mandated by the Federal government to see every patient to determine if they have a emergency medical condtion, but the clinics/primary care doctors have no such mandate.

Now that you're on the business / administrative side, do you miss the hands-on stuff?

Asked by deadwooood over 6 years ago

I love the administrative and business end of the job! A nurse geek! I worried that I wouldn't be taking care of patients, but I’m in the ER a lot of the time assisting during busy times and talking to patients and families when they have concerns. It is just the right balance for me. When I was involved in direct patient care, I was taking my work home with me (emotionally). I continually wondered if I had given the best care or had made mistakes. Now, if I miss a spreadsheet deadline or am late for a meeting, it is not affecting the patient at that moment.